Obama's Plan B decision puts girls at risk

Margaret Moon

A society is at its worst when it leaves its most vulnerable citizens exposed so that its most powerful can hide from ugly realities. In the case of Health and Human Services Secretary Kathleen Sebelius' ruling to reject the Food and Drug Administration's expert opinion regarding access to emergency contraception for adolescent girls, the ugly reality is that teenage girls engage in unprotected sexual intercourse. Unprotected from pregnancy due to lack of effective contraception, unprotected from sexually transmitted illnesses including HIV, unprotected from the aggressive sexual content of popular media and advertising, unprotected by social and family networks that ought to be looking out for them.

Maybe most importantly, unprotected from a political system that will hide behind the language of science to promote a patently self-serving election agenda — and even a president who can try to claim innocence tempered by full support for whatever misguided (and possibly poll-driven) decisions his subordinates make.

A little bit of sanity, please. The best data available, according to the FDA, show that Plan B emergency contraception is safe for women capable of becoming pregnant. Much safer, in particular, than pregnancy. Safer than abortion. It is most effective when administered soon after unprotected intercourse. The delay involved in requiring the extra step of a prescription is likely to diminish the effectiveness of the drug for those who need it the most.

Ms. Sebelius' expressed concern that the safety data on Plan B is skimpy when it comes to girls age 11 may be sincere. However, much of our pharmaceutical safety data is pretty skimpy in that age group. It is hard to conduct extensive drug safety trials in children, but use of medicines with incomplete pediatric safety data is very common. President Barack Obama's concern about young teens "able to buy a medication that potentially if not used properly could end up having an adverse effect" would also apply to over-the-counter medications as common as Ibuprofen, Tylenol, vitamins with iron and cough syrup. To single out this particular drug is illogical. There are no age-related marketing restrictions for safety reasons for any other oral contraceptives that the FDA has approved.

The good news is that 11-year-old girls having regular sexual intercourse is pretty rare. The 2009 Centers for Disease Control and Prevention's Youth Risk Behavior Survey reports that 45 percent of girls in grades 9-12 reported ever having had sexual intercourse. Breaking it down by grade shows how quickly the numbers rise: 29 percent of ninth-graders, 40 percent of 10th-graders, 52 percent of 11th-graders and 65 percent of 12th-grade girls report ever having had intercourse. Only 3.1 percent of girls reported having had any sexual intercourse before age 13. Pregnancy rates tell the same story. In 2006, according to the Guttmacher Institute, 3.2 percent of girls ages 15-17 became pregnant, compared with 0.7 percent of girls under age 14.

An 11-year-old girl at risk of pregnancy deserves every ounce of protection any of us can provide. The problem is that Ms. Sebelius, in overturning the best scientific advice available, has not done anything to increase protections for that very young, very vulnerable girl. At the same time, the decision limits access to a safe and effective medication for older teens at much higher risk of pregnancy.

I am not in favor of young teens having unprotected sex. I am in favor of protection — protection that ought always to include the full complement of parental, medical and social measures to keep our most vulnerable citizens safe. No teenager should have to face a concern about unwanted pregnancy without the help of a thoughtful and loving adult. Unfortunately, many of them do. It is a hard time to be a teenage girl in our society. Pressures are massive, messages about sexuality are harsh and suggestive, and protections can feel very, very slim.

This is not the time to engage in wishful politics. A decision that our youngest adolescents should have fewer measures to avoid unwanted pregnancy than those enjoyed by women with more power will not help young teens avoid pregnancy. It will not stop young teens from having sex, and it will not encourage parents to have more and more-effective conversations about sex and values with their children. It will just make pregnancy more likely.

Dr. Margaret Moon is the Freeman Family Scholar in Clinical Medical Ethics at the Johns Hopkins Berman Institute of Bioethics. Her email is mmoon4@jhmi.edu.